Provider Demographics
NPI:1659546075
Name:KOKORIN, YEVGENY (LAC)
Entity Type:Individual
Prefix:
First Name:YEVGENY
Middle Name:
Last Name:KOKORIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 INVERNESS CIR E
Mailing Address - Street 2:BLD F-103
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5304
Mailing Address - Country:US
Mailing Address - Phone:720-299-8278
Mailing Address - Fax:
Practice Address - Street 1:88 INVERNESS CIR E
Practice Address - Street 2:BLD F-103
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5304
Practice Address - Country:US
Practice Address - Phone:720-299-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-26
Last Update Date:2008-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1388171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist